"If you're pretty crazy then you're in good company because the human race as a whole is out of its goddam head." Albert Ellis - founder of Rational Emotive Behaviour Therapy (REBT) and pioneer in the development of Cognitive Behaviour Therapy (CBT).

By way of review, look at the diagram below regarding the differences in the roles both sides of our brain play. When the right hemisphere is more active it floods us with negative thinking , bad memories and uncomfortable emotions.

In order to get the left side of our brain more active to balance things up a bit, we can actively and consciously engage in cognitive challenging or restructuring. The following strategy forces a sub-conscious thought into our working memory where it is 'worked with' and processed to a deep level to then be transferred into our long term storage to be accessed at a later date. The idea being, we want to make more balanced, rational and helpful thoughts our go-to automatic belief systems through which we view and interact with the world around us. Read on to learn how.

What is a Core Belief?

Core beliefs (also called schemas) are thinking patterns that act as templates that we can use to help us perceive and interpret our experiences in life. We have lovely, healthy balanced ones, we have neutral ones, and we all also have maladaptive, distorted ones. The latter are the ones that sometimes cause us problems in our lives and they're the ones we focus on in therapy because, well, they cause us the problems!

The ABC Model.

The ABC Model underpins all cognitive therapies. You can read much more about it in our article Thinking Tools 101 and at the Centre for Clinical Interventions website (details below), but for now, it's enough to know the following.

A = Activating EventB = BeliefC = Consequence (feelings/emotions)

Examples of Unhelpful Thoughts and Core Beliefs in Depression:

I am a failure, anything I do or try will ultimately fail.

I'm hopeless and worthless.

I'm unlovable.

People will be better off without me in their life.

Life is too hard and it will never get better.

Nothing good ever happens to me.

I'm not good enough/smart enough/attractive enough/funny enough

Why do we need to challenge our unhelpful thoughts and beliefs?

Because they make us feel more discomfort than we need to and they often impact on how we live our life. They can make us avoid situations that might ultimately be good for us, meaning that we miss out of opportunities. Worse still, it can mean that we miss out on life.

Unhelpful thinking can also get in the way of our relationships with others, making us feel and act in a hurt or defensive way, leading to withdrawal or other unhelpful behaviours.

Sometimes, instead of identifying and working on our core issues, we seek short-term solutions to feel better and sometimes those solutions can cause problems of their own. For example, drinking alcohol to block our pain or distract from our problems, or to 'take the edge off' and relax. It's good in the short-term, but it never really solves the problem.

So, one thing we can do to start making some permanent changes in our brains, is to challenge our faulty thinking - figure it out, challenge it, change it. It'll definitely help make you feel better and get back into your life.

How to Challenge Your Unhelpful Thinking:

Step One:

Be sure of your ABCs. Often we need to work backwards because many of our unhelpful thoughts and core beliefs are very old and familiar and occur automatically, often subconsciously. This means that we'll often feel the feeling (C) first.

So, what are the uncomfortable emotions and feelings you've been having lately that you'd like to improve or change? Some common feelings that bring people into the clinic include feelings of sadness, hopelessness, worthlessness, fear, anxiety, anger and irritability, to name but a few.

From there, it's important to reflect on which types situations (A) trigger your unhelpful thoughts and beliefs resulting in those uncomfortable emotions (C).

Once you're aware of the kinds of situations, perhaps even the types of people you are around when these feelings often occur, you're in a better position to be able to hypothesise about the kinds of thoughts you might have in such situations. You know yourself well, and while it often takes some time to analyse and interpret our thoughts, we need to be aware of the actual core negative belief or fear before we can begin challenging it.

For example, a young client came to me recently, upset at overhearing a peer speak negatively about something my client was doing. My client was still upset several days later and missed a day of school straight after the event.

We began with her emotions (C) and linked those to the situation (A) in order to figure out the kinds of thoughts my client had at the time - what had she told herself about the situation (B).

Why me?What did I ever do to her?Why doesn't she like me?What if the person she said it to, doesn't like me now?

Knowing that my client experiences social anxiety, I realised I had to help her dig a little bit deeper to get to the core of the issue. I used questions such as, "and what would be the worst thing that could happen if those two people don't like you?", "and what would be the worst thing about that?", until she was able to identify that her core belief/fear was that nobody likes me and one day I'll turn up to school and have no friends.

You can see how one situation, involving one person making a negative comment about a singular behaviour, managed to turn into a catastrophic scenario in my client's mind where she was unable to face anyone at school the following day, impacting on her education.

To recap Step One - be clear about your ABCs!

Step Two - The Challenging Questions

Please note, there are many ways to challenge an unhelpful thought and I'll include a resource list at the end of this article, but here are some of my favourite challenging questions. The point of this part of the exercise is to take the irrational/unhelpful belief and highlight just how irrational or illogical it is.

As an example to highlight how to challenge an unhelpful thought, we'll use one of the examples from above: I am a failure, anything I do or try will ultimately fail.

What is your evidence for the thought?(Evidence must be factual! Not other unhelpful thoughts or feelings)

I didn't succeed at getting the job I interviewed for and the roast I made for dinner last night was overcooked.

What is your evidence against the thought?

I've never actually been out of a job. Most nights the dinner that I make turns out well. I have many friends who all tell me that I am good at the things I do.

Is this thought a habit or a fact?(Our automatic thoughts are so familiar, we often get tricked into thinking they are facts but this is usually not the case!)

I've been telling myself for a long time that I'm hopeless and a failure and there's all this evidence that I don't fail at EVERYTHING, so it must be a habit.

Is it taking into consideration all the parts of the story or is it just focused on one aspect? (Often we'll be focussed on the one little negative aspect of a story because it hurts, but what would happen if we also included all of the positive and neutral aspects to the story too, to balance things out?)

I'm focused on just the one job I missed out on and not the last five that I actually got.

Is the thought black and white? (When you use words like 'always', 'never', 'everyone', 'noone' etc. your thought is likely to be an All or Nothing/Black & White kind of thought. This is never good!)

My thought is black and white because I'm telling myself that I fail at EVERYTHING.

Is it extreme or exaggerated in any way?

Yes

Is the source of this thought dependable? (Often the source of our thoughts is fear or another emotion, even low self-esteem or confidence. These are never reliable sources!)

My thought is driven by my depression and my emotions are never reliable sources of information because they are biased.

Is the thought confusing something that is possible with something that is probable? (We totally do this. All. The. Time. So stop it!)

Yes, it's possible that I will fail some things, but not most of the time. My brain is acting like I will fail most of the time when that is not true.

Is the feeling based on feelings or facts? (If you've gotten to this stage in challenging your thought, there's no way your thought is a fact...)

Feelings.

What's the worst thing that could happen in this scenario?

That I will fail at everything I try.

What's the best thing that could happen in this scenario?

That I will succeed at most things I try.

What's the most likely thing that will happen? (Usually we find that the Best and Most Likely case scenarios are EXACTLY the same! Who'd have thought that could be true?)

That I will succeed at most of the things and try and fail at some things as well.

What benefits does this thought provide? (Usually there are none...at this point, clients usually try to tell me that the thought drives them to strive for great things, but if they're honest with themselves, they can usually see that it only adds unnecessary pressure.)

None that are helpful.

What are the disadvantages to listening to this thought? (Usually there are heaps... they can be emotional discomfort, practical implications, anything that gets in the way of you living your value driven life really...)

It makes me feel really disappointed, sad and depressed. It makes me doubt myself and feel hopeless about my future. It makes me want to give up and not try to achieve anything. It makes me want to avoid my friends and family, making me feel even lonelier and more hopeless than ever.

Step Three:

Identify which Unhelpful Thinking Style your thought belongs to. The entire point of Step Three is to further highlight that your thought is an UNHELPFUL one. Red Flag anyone?

Is it Jumping to any Conclusions?

Are there any Shoulds or Musts in your thought?

Is it Oversimplifying or Overgeneralising?

Are you attempting to be a Mind Reader?

Is it using Emotional Reasoning?

Are you Catastophising?

If you answered 'YES' to any of these, then your thought is definitely NOT one for you to be spending anytime with much less listening to!

You can read more about Unhelpful Thinking Styles on the Centre for Clinical Interventions website.

Step Four:

Generate an alternative, balanced, helpful thought/belief about the situation.

For example, if the core belief is "I am a failure, anything I do or try will ultimately fail" a more balanced alternative might be "At times I will fail at the things I try, but I will also succeed a lot of the time" and "Life is about learning from our failures and it's normal to have both failures and successes in life."

Step Five:

Check in with the original thought. Do you still believe it as much as you did? It's likely that you won't. You might be more in favour of your new alternative belief by this stage.

Step Six:

Check in with any changes in your feelings and emotions and notice the positive changes. Feeling better will motivate you in the future to consciously manage your thinking in order to reduce emotional discomfort.

Step Seven:

Notice the differences in your choices about how to act and what you are able to do now with your new thought/belief in place. You'll probably find you're more willing to approach life than avoid it which will improve your overall mood and quality of life.

Thank you for reading our article on cognitive challenging, we hope you've found it useful. If you have any comments or questions, be sure to contact us. Stay tuned for our upcoming articles on post-natal depression and grief and loss. x

Three hundred million people world wide live with depression. The Black Dog. The Dark Storm. The Tar Pit. The Black Hole. But what is depression and what causes it? Read on to learn the opinions of several mental health clinicians in this first of our The Psychology of It series on depression.

The publishing of this article just so happens to coincide with The Psychology of It's first birthday, so perhaps the very first question needs to be, "why did it take a psychological website twelve months to write specifically about depression?" Well, that's an excellent question and to be honest, I think I've been avoiding writing about depression because it's not a straight-forward disorder to describe. Clients come into the clinic with the same diagnosis of "depression" and yet can have extremely different presentations in mood, thinking, behaviour, functioning and even general appearance. So, to get me started, I called on the help of my team. Here's what they had to say:

What is Depression?

The Psychiatrist:

Depression consists of a number of symptoms including: low mood, incapacity for pleasure, sleep and appetite disturbance, slowing of thinking, often with suicidal thoughts or behaviours.

The Mental Health Nurse:

Depression is a medical term used to describe a cluster of symptoms found in some people who are experiencing a certain set of symptoms. These symptoms can be experienced at differing levels of severity as well. It is also a term used by people in the community to describe a feeling of sadness that is but one of symptom of depression - the illness - so, in some cases the terminology can be confusing.

The Social Workers:

Depression is usually defined by a number of symptoms including mainly lowered mood, feelings of sadness and worthlessness, everything is an effort, poor motivation, increase/decrease in appetite, increase/decrease in sleep, negative thinking, possible thoughts of self-harm, increased tearfulness, don't want to be here, withdrawn behaviours, avoidance...

A deep feeling of sadness, feeling of being lost, or not feeling at all for a long period of time with limited ability to react positively or 'happily' to things that should make us feel good. Lack of interest in usual activities or decreased motivation to complete usual daily tasks, social isolation, disturbed sleep or sleeping too much, lack of ability to identify any goals (short or long term).

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What I love about their joint answers is that together, they cover all of the symptoms of depression, yet use their own personal language, likely based on their current clientele living with depression. There are a large cluster of symptoms that make a depressive illness and people only need a combination of five of them, along with other qualifiers in order to receive a diagnosis of major depression.

Here is what our Diagnositic Statistical Manual of Mental Disorders, 5th Edition (DSM V) lists as criteria for major depression.

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day - this might be indicated by feelings of sadness, emptiness, hopelessness, tearfulness etc. and in children and adolescents it might be irritability.

2. A significantly reduced interest or pleasure in all, or almost all, activities most of the day, nearly every day - especially things that would normally derive pleasure and enjoyment.

3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.

4. Sleeping difficulties or a need to sleep more nearly every day.

5. Psychomotor agitation or retardation nearly every day - this might be a slowing down of movements and speech, or a constant need to move and inability to sit still.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder or a psychotic disorder.

E. There has never been a manic episode or a hypomanic episode.

If someone does meet enough of the above criteria, major depression can then be further specified with any of the following types:

When making a diagnosis, we must take into account a person's unique background and circumstances, their cultural beliefs and what would be a normal emotional reaction, and duration for that reaction within the context of their circumstance. For example, responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the contest of loss.

While a major depressive episode lasts at least two weeks, it can last a lot longer. Once it goes away, the person may never experience another one, or they might experience more throughout their lifetimes. It works differently for everyone but we can describe episodes using common terms such as current or past episodes, single or recurrent. There's another kind of depression not as severe at major depression, but one that lasts longer - years even - called a dysthymic disorder. Depression also features in Bipolar Affective disorders.

See how un-straightforward depression? Any wonder I put it off and put it off...

Now that I've given you the literal words from our diagnostic bible, it wouldn't be fair to not give you my impressions and observations on depression. Here we go:

The Psychologist:

Depression is debilitating and distressing, not only for the person experiencing it, but for those caring for and surrounding them. Depression is not a choice - nobody chooses to be depressed. Depression is no-one's fault. Usually, the person with depression knows exactly what they 'should' do, but they really just can't get out of bed/go for a walk/call for help/go to work/eat anything/smile. Not all depressed people are suicidal BUT every depressed person I've ever met wishes they didn't feel depressed. Depression robs people of the ability to live their life.

"I sometimes feel as though I'm trying to move my entire body through tar. My limbs feel so heavy and the movements are so slow. My mind feels just as sluggish. I can't concentrate. I can't remember things. My head feels fuzzy all the time and I just can't get going. I just can't get motivated to do anything and I can just lie in bed all day and sleep. It's hard not to feel hopeless about ever feeling better." Anonymous client.

What Causes Depression?

The causes of depression are not simple or straightforward. Depression has been documented since Ancient Greek and Roman times when it was referred to as melancholia and thought to be caused by evil spirits! More recently, depression was thought to be caused by a "chemical imbalance" but we now know that it's a lot more complex than that. Once again, I asked my colleagues for their opinions on what causes depression. Have a read.

The Psychiatrist:

There are a number of "depressions" with different patterns, acute, chronic, persistent, recurrent and different causes, genetic, environmental, which need different treatments.

The Mental Health Nurse:

The causes of depression are varied from post-partum, grief, trauma, genetic theories, theories of imbalance of serotonin in the brain or the result of the use of psycho-active substances such as alcohol or stimulants (but more in the come down for stimulants), difficulty adjusting to changes in life or roles, bipolar disorder, over-worked or over-stressed individuals. The best way to understand the onset of depression, I think, is through the stress vulnerability model essentially saying that we all have a vulnerability to mental illness and whether one develops the illness is dependent on a range of variables. I don't think it's sufficient to say one thing in a person's life causes depression but rather a combination of factors. For want of a better term, the "perfect storm".

The Social Workers:

The causes can be multiple. Depression could be triggered by stress, e.g. work stress, home life, family relationships, post-natal depression. Depression can be related to trauma, sexual abuse, a sudden death, loss of a job, relationship break-up. Genetic make-up may also contribute to depression through a genetic predisposition or strong family history of depression. Environmental and financial factors or other potential triggers for depression. Other causes may include complex medical conditions, thyroid issues, hormonal issues, or living with chronic illness.

Depression can be caused by changes in our brain which affect the pleasure system. This can be caused by changes in our life circumstances or a significant life event e.g. grief, trauma, loss or change in identity, bullying, family conflict or breakdown, birth of a child, social isolation etc.

The Psychologist:

Once again, my colleagues have raised all of the key points when it comes to how to we understand the causes of mental illnesses in general, and that is, that the causes are typically multi-factorial - it's never just one single thing that causes the onset of depression.

For example, a depressive disorder that arises in winter has a different trigger than a severe depression following the loss of a loved one, even though the depressive episodes might look similar for both.

There's a lot of research being undertaken that is identifying biological (physical factors such as genetic makeup etc.), psychological (stress, trauma, personality traits etc.) and social (socioeconomic status, environmental considerations, social support etc.) factors which appear to be strong contributors to the development of depression regardless of whatever the triggering event is.

It's important to realise though that although there may be a family history of depression, it is not a foregone conclusion that other family members will automatically also develop a depressive disorder. Drug and alcohol use and exposure to other toxins through diet and the environment are also risk factors. Coping style and cognitive styles also influence a person's likelihood of developing a depressive disorder. The list goes on and on.

In summary, it takes a combination of contributing factors to lead to the onset of depression.

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A big shout out to Mark, Damian, Kellie and Graham for helping me out with this article - thanks guys! I'm excited to say that guest writer and psychiatrist, Dr Graham Ridley, will be writing for us about the many and varied pharmaceutical treatments for depression and I will be writing about the psychological behavioural and cognitive treatment modalities used in the 'talking therapies' to treat depression.

If you've enjoyed this article, please make sure you look out for our follow up articles. As always, we appreciate your feedback, likes and shares! To make sure you don't miss out on our best articles, subscribe to our website on the home page and make sure you share us with your friends. x

In early September, 2016, we discovered by chance a Facebook post by Christopher Sewell describing in raw detail, his first-hand struggle living with anxiety and depression. Christopher is a husband and a father and a surfer and a mate who is not defined by his disorders. Instead, he is brave and generous and shares this incredible insight into his experiences.

If you could describe your mental illness as a colour/s, what would you say?

If mental illness was a colour? I don't think mental illness can be pigeon holed into a single colour. For me it's too complex for that. I find it to be a swirl of earthy colours - greens, greys, browns and off whites. As time passes colours change, they repeat themselves and even merge together. It's a confusing time. A spiral within a circle (of colour).

Can you tell me perhaps your Top 3 (or 5, or 10!) things you'd like people to say and/or not say when you tell them about your mental illness?

The first thing would have to go at the top of both the top 3 things to say and top 3 things not to say. And that is "Are you ok?". I know that's contradictory , but let me qualify that statement. The days when I thought I had everyone bluffed were some of the days that people most noticed I was struggling. Imagine having your primary school aged children ask if you're ok. Those are the days you don't want to be asked "Are you ok?". And I realise now they're the days you need to be asked this question. After that question, everything else follows.

Which film best describes your experience living with mental illness?

"Fight Club". Although it is essentially a film about mental illness, you don't realise this until the end. You pretend you're something you're not. Days merge into one another and sometimes it feels like you're observing the comings and goings from third person. There is also the premise that until I hit rock bottom or accepted my struggle I couldn't move forward.If there was a single scene from a movie, it would have to be "Kill Bill Vo.2" and the buried alive scene. While there is no dialogue, the emotion and symbolism of this scene fits perfectly.

Is there a metaphor you use to describe what it's like to live with anxiety that helps other people understand a little of what it must be like for you?

I think the metaphor that best explain both anxiety and depression is that of being trapped under ice.You do your best to do a balancing act across an unstable terrain. Reassuring yourself that you will be fine. It's just a matter of making it safely to the otherside. Suddenly cracks form. One turns into two, two into four. Then in a instant you're falling quick and hard. No matter how much you try to call out or bang against the underside of the ice, no one can hear you. You're able to see what's happening above, but no one can see you or help you. It's cold, lonely and a struggle that you feel like giving up.

What helps?

Exercise. Doesn't matter what or how good you are at it. For me, it was both mountain biking and surfing. These things still need to be in moderation. Sometimes I would ride until I could no longer turn the pedals. I would ride to complete exhaustion as some sort of self inflicted punishment.

The other thing that helped was meditation. Not in the way of taking classes or in a structured way, but in managing breathing. I found out I was breathing twice as fast as someone not in my position. It's amazing how much energy is used and worn out you can get from this.

What makes things worse?

Not dealing with any issue that might arise from day to day. Answering the phone, making decisions at work. Not asking for help because I thought I was useless and worthless. Bottling up frustration and sadness.

Did you receive a diagnosis? Was that useful? Has that changed over time? Was it a straight forward process?

A diagnosis good, bad or otherwise is a great starting point. It helps with the acceptance of what is happening. Until I accepted my situation I don't think I could have moved forward. My depression was diagnosed as being hereditary. Regardless of the reason, knowing there is a reason makes it easier. It is so confusing and upsetting. Why me? I started questioning every decision I have ever made. That's not a good train of thought.

What would you have liked to have known earlier on that may have changed your experience?

The confidence to seek a second opinion is important. As in the different types of depression and anxiety, not every treatment and/or mental health professional is suited to every sufferer. I think people are aware of their right to seek a second opinion. It's having the certainty to follow through. Having family or friends as a sounding board helps alot.

Who has had the most positive impact on you, and your recovery journey? (Do you even like that wording?..recovery).

I don't think there is any one person who has had the most positive impact on myself. I think it's a collection of trained professionals, family and friends. People help in different ways at different times.

There are two words that describe post depression/anxiety that are relevant.

Recovery and Management.

For a percentage of sufferers recovery is the correct word. By identifying and changing unhelpful thoughts and behaviour, Introducing coping mechanisms and strategies and in cases short term medication a person can return to the same point they were at pre depression/ anxiety.

For the remainder I think it's about management. People in this category use all the same tools as those in the recovery, with the exception of prolonged medication use. This could be because of a number of factors. It could be due to the nature of their illness, chemical imbalances, situational factors. No two people are the same. They may be similar, but not the same.

We'd like to say thank you to Chris for this Up Close & Personal account that was all at once moving, raw and insightful. We're sure it will help many people. If you have any comments or questions for Chris, be sure to leave them below and if you have a story to share, feel free to be in touch via the website or email jodie@thepsychologyofit.com.au.

I first met Lisbeth several years ago in The Literary Kitchen where we were both writing students of American author, Ariel Gore. We reunited two weeks ago back in the Kitchen in a Personal Essay Intensive class. This very personal essay about Lisbeth's experiences living with and managing bipolar affective disorder and symptoms of psychosis lept from the computer at me and I begged her to share it with us at The Psychology of It. We're so grateful she did.

Lisbeth Coiman is a bilingual writer standing (unbalanced) on a blurred line between fiction and memoir. She has wandered the immigration path from Venezuela to Canada, to the US, and now lives in San Leandro, CA. She writes, albeit irregularly, on her blog www.gingerbreadwoman.org, a bilingual conversation about mental illness. Her work has appeared in HipMama Magazine, the Literary Kitchen, and YAY Magazine. Her upcoming memoir, The Shattered Mirror, celebrates friendship among women and draws attention to child abuse and mental illness.

Research proves individuals with diagnosed mental disabilities do better when they have continuity of mental health care, or live in long-term loving relationships, or have a strong caregiver by their side. For years, I had two of those factors. I enjoyed the best medical service I could afford with a generous medical insurance policy, and lived in a long-term loving relationship.

Since leaving my husband and moving to the East Bay, I have not been able to find adequate therapy. I count on the services of a psychiatrist I don’t fully trust yet for once a month medication management.

Additionally, I can no longer check reality by asking my partner questions.

Do you see that? Is this real?

Nor can I find the emotional support I once had when he used to hold me in his arms if I felt overwhelmed, hunted, or “followed” in any way.

My difficulty in living alone is not that I need help moving furniture, or paying my bills, or not knowing what to do if my refrigerator breaks. The difficulty lies in that I suffer from bipolar disorder and psychosis, and I lack the supportive system to carry on in a crisis.

In the last year, I have gone to work several times feeling close to a mental crisis, once with suicidal ideation. At those times, I repeated to myself in the car on my commute to work, “just put one foot in front of the other, Lisbeth, just keep moving forward, and remember to smile.”

For days like that, I keep my doctor's phone number, and a short checklist to self-monitor my symptoms.

Lisbeth's Self-monitoring Checklist & To-Do List

1. Self-referencing ThoughtsIf I believe any of the following:

a. The news reader on tonight's news broadcast is refering to me,b. The messages on loudspeaker at the grocery store are coded instructions to keep an eye on me,c. Or, the unknown people with their heads close together at the end of the corridor are talking about me,

I am definitely paranoid, and should call my doctor to adjust my medication.

2. Suicidal IdeationIf I have thoughts that involve any of the following several times a day:

I am suicidal, and need to get out of the house immediately, into endorphin producing exercise. Yoga, hiking, power work-out at the gym, 5K walk, and dancing make me feel better. I should also avoid refilling any prescriptions when having suicidal thoughts.

3. Wrong, Senseless ChoicesOnce a small bug in my kitchen sink triggered a panic attack. I was having a bad week already and was prompted to crying over the slightest thing. At that point, my first reaction was to call 911. I’m glad I didn’t. I called the apartment manager and demanded that she removed the bug from the sink. I also asked her to spray the apartment.

If facing the same situation again, I should get my act together and kill the bug myself (But I might still demand that the administration sprays the apartment!)

4. Creepy Crawly SkinIf I feel bugs crawling up my legs while sleeping in the middle of the night, I should consider the following:

a. It might be a symptom of menopause, in which case I should take a shower and chill out.b. Maybe I’m just reacting to the laundry detergent. I should use some soothing body lotion.c. There could actually be a spider on my bed. Then, I should check the bed and kill the creature (preferably without calling 911).d. But if none of the above, then it might be that I just experienced a tactile hallucination.

Tactile hallucinations don’t kill. The annoying sensation irritates me. I should drink a calming tea like chamomile, and strike something soft, like a stuffed animal, or a pillow. Crocheting also helps. The idea is to transfer the tactile anxiety to a pleasurable sensation.

5. Rapid ThoughtsAround bed time, when my chores are done and I have time to relax, my mind starts racing. “I should have replied to that woman in, weak reaction sends, careful with my job, rent in the East Bay, back to Oklahoma, racist there, finish writing my book. What if I get sick, no money or security, …”

If I notice this happening, I should stop and do a simple five-minute meditation, breathing deeply in and out, using a mantra, or just counting my breaths. Also Valerian root tea does wonders for the unquiet mind.

6. Inability to Make Small DecisionsIf any of the following happens:

a. Cry because I can’t decide what to eat.b. Come in and out of the house four or five times unable to just go.c. Spend half-an-hour trying on and changing clothes, then run late for work.

Planning ahead helps solve this problem. I plan my menus once a week, knowing exactly what I will eat at breakfast, lunch, and dinner on any given day. I plan my routine a week in advance. Even if I don’t manage to do everything, at least I have a clear idea of when to leave the apartment. Line up a day-by-day weekly wardrobe on Sunday evenings. It's better to be taken for obsessive compulsive than to be late for work because of inability to decide what pair of shoes to wear.

7. Excessive CryingIt’s hard to stop crying when I’m depressed. I cry at the news, at rude comments, when trying to make small decisions, when I am nervous before speaking in public. It's hard to explain to others when I am caught crying,for example, in the office.

I try to be honest if somebody finds me wiping my tears. Anybody can understand, “I’m having a stressful day.” These are a few alternative excuses.

a. Pollen allergies are killing me.b. I got a reaction from my make up. I shouldn’t use that brand anymore.c. I laughed so hard at Taco Tuesday jokes, I am crying.

8. Self-pity PartyWhen the following scenario occurs, I should listen to my friends.

My friends the punk Chicana, my neighbor the tarot reader, and the sexy business woman gather in my small apartment via Skype while I sit in my sofa with a laptop on my knees. They have their margaritas ready. I sip from my 5 oz. glass of wine, and say, “It's the politics I can't handle. I don't know what else to do. I come home crying most days. I’m tired. Why is everything so difficult for me? What is it with me? Why do people tend to hate me?”

I should listen to the punk Chicana when she interrupts, “stop there. You are now officially wallowing in self pity.” Margarita slurps are heard over Skype.

9. AbsurdityQuestion this reality:

a. If your purse is talking to you, chances are the GPS app on my phone is still on.b. If the refrigerator is ringing, I must have left my phone inside.c. If there are Taco Trucks on every corner, maybe Hillary won the elections.

10. Compulsive BehaviorsIf I find myself:

a. checking my messages on the phone every two minutes,b. making minute-by-minute To-Do lists for the next day,c. or organizing the spice drawer in alphabetical order,

I should engage intellectually in reading or writing, or problem-solving, and leave the telephone at home to avoid checking messages.

11. Lack of PerspectiveWith a roof over my head, with an income, and a healthy family, there is no tragedy. There is a tragedy in Syria and in Venezuela. Get real.

If everything fails, call the doctor, or the suicide hotline. And repeat the following:

Sandra Bucci is of Swiss-Italian heritage and a Novacastrian now residing in Manchester, U.K., with her husband and two beautiful children. She is a Dr of Clinical Psychology and an academic at The University of Manchester; her academic interests lie in understanding the development and maintenance of psychotic experiences such as hearing voices and having unusual beliefs. She is motivated to develop novel ways to help people have better access to mental health support and intervention. Sandra is a world citizen who has travelled extensively. She is a former competitive aerobics champion, tennis player and doesn't particularly like being in a field of cows (one might go so far as to say she has a bovine phobia!).

I first met Sandra in 2006 when she became my very first clinical supervisor! How lucky am I? Sandra has helped to shape my psychology career from day one. In this incredible Conversation on the Couch, you'll get a glimpse of the kinds of thoughtful reflections I learned from early in my career. Thank you Sandra! Australia misses you. x

If happiness was the national currency, what kind of work would make you rich?I think it would be simply sitting and being with people during times of distress, listening to someone's story, and being able to help someone in a time of need without the pressure of filling out paperwork, meeting attendance targets and so on. I can honestly say I would be a clinical psychologist over and over again. It is an extremely privileged and rewarding job - bearing witness to someone's story is incredibly powerful.

Why are you, you?I am a product of my upbringing and the way I choose to appraise situations that arise. A number of experiences have shaped who I am and who I choose to be today - my family environment, peer influences, getting through life relatively unscathed, having good attachment figures and models in my early life that have helped me develop my sense of self and feel a sense of belonging and connection with others - these experiences have given me an inner confidence and sense of who I am, the values I hold and how I choose to behave.

Would you rather lose all of your old memories, or never be able to make new ones?I think I would keep all my old memories - it's what makes me, me. I don't know how I could develop a sense of self without knowing where I have come from.

When is it time to stop calculating risk and rewards, and just go ahead and do what you know is right?It's a cost-benefit analysis. There are times when you have to just let things go - pick your battles rather than being constantly at war. There are times, though, when you just simply need to stand your ground. I think as you get older you learn to trust your instinct more and start listening to your gut reaction - it is usually right!

What would you do differently if you knew nobody would judge you?If life was judgement-free, I would do and say more of the things I felt instinctually were right. I recently travelled abroad for work. I was away from my children for a fortnight while they were with their dad. When I returned, the judgement from some for leaving my children was palpable. People I barely knew approached me about it in various ways, via social media and in person. Rather than telling these people to f*&% off, I fed into the discourse of being a bad mother for leaving the children and travelling for work. I was really disappointed in myself for feeding into their judgement about a decision I made that was right for me and for my family. The thing I realised later was that it wasn't actually their judgement that was the issue, it was my own self-judgement that was more damaging. I think the pertinent issue here is not the fact that others judge you, but the self-imposed judgement and inner critic that, if we could be free of, would help us be more honest with each other and free us up from worrying about what others think of us.

What are you pretending not to know?Ah yes, the known unknown. My husband and I left my hometown nearly 10 years ago and started a new life on the other side of the world. The time spent away from my family and the friends i have grown up with is a void that can never be filled. I am pretending that it is OK to have lived a big chunk of life away from all that I have known and from the people who have shaped and influenced who I am today. I am pretending that I will not regret spending 10 years of my life away from my elderly mother, who, until the birth of my children, has been the most important and influential person in my life. I am pretending that the pain she felt when I left home was softened with the knowledge that I was pursuing a dream that wasn't achievable in my hometown. My own children will no doubt have the same desire to spread their wings and I might be left feeling the way my mother felt when I spread mine. I know this is coming, but it's safer to pretend that it won't!

Thank you for joining us for another insightful Conversation on the Couch. Stay tuned for our next conversation when six-year-old Scarlett interviews Jodie. Don't forget to leave Sandra a comment and share us with your friends!